Perihematomal Diffusion Restriction in Intracerebral Hemorrhage Depends on Hematoma Volume, But Does Not Predict Outcome

Abstract

Background: Perihematomal diffusion restriction (PDR) is a frequent finding in primary intracerebral hemorrhage (ICH) on diffusion-weighted MRI. Its frequency, associated clinical and imaging findings and impact on clinical outcome are not well understood. Methods: This is a retrospective single-center analysis of 172 patients with primary ICH who received MRI within 24 h from symptom onset. PDR was defined as a reduction of apparent diffusion coefficient below 550 × 10^-6 mm²/s. Multivariate regression analyses were used to assess independent imaging and clinical predictors of PDR. Clinical outcome was assessed using the modified Rankin scale (mRS) at discharge. Results: PDR was present in 88 patients (51.2%). Median PDR volume was 1.1 ml (interquartile range 0.2-4.2). Multivariate analyses identified hematoma volume as the key independent predictor of PDR. The volume of perihematomal edema, lobar hematoma location and low diastolic blood pressure at admission were further predictors. Although the occurrence of PDR correlated with in-hospital mortality (75.0 vs. 43.4%, p < 0.001) and moderately severe to severe disability or death at discharge (mRS ≥4; 56.4 vs. 27.8%, p = 0.002), PDR was not an independent predictor of clinical outcome. In contrast, hematoma volume, ventricular extension of hemorrhage and higher age independently predicted an adverse clinical outcome. Conclusions: PDR is common after primary ICH within 24 h of symptom onset. Hematoma volume was identified as the key predictor of PDR. Although PDR was associated with mortality and severe disability, this effect was confounded by established risk factors. These results do not support a role of early PDR as prognostic factor after ICH independent of hematoma volume.

Lesional and perilesional tissue characterization by automated image processing in a novel gyrencephalic animal model of peracute intracerebral hemorrhage

“…40 Recent studies showed that perihematomal diffusion restriction depends on ICH volume, but does not independently predict outcome although the diffusion restriction correlated with in-hospital mortality and disability rate or death. 41 However, other studies indicate that the perihematomal edema expansion is associated with poor clinical outcomes. 22,42 Reports from patients after ICH and from other animal models also showed perihematomal tissue changes including perilesional edema.…”

Perihematomal diffusion restriction as a common finding in large intracerebral hemorrhages in the hyperacute phase

“…The most recent study by Stösser et al . showed a PDR in 88/172 (51.2%) IPH patients within 24 hours of symptom onset, but they did not separately examine the subgroup of patients in a hyperacute or 6-hour time window [ 12 ].…”

“…Within the PHE, the occurrence of patchy ADC hypointensities has been described [ 6 – 14 ]. 3 studies suggested that this phenomenon also occurs in hyperacute IPH, but no systematic study on this topic has been performed [ 12 – 14 ]. Furthermore, quantitative ADC measurements of the PHE area are lacking.…”

Rules-based Volumetric Segmentation of Multiparametric MRI for Response Assessment in Recurrent High-Grade Glioma

“…Voxels within VOI3 were classi ed as Fluid based on hypointensity on calibrated FLAIR or high ADC (≥ 2130 µm 2 s − 1 ), as hemorrhage based on either very low ADC (≤ 550 µm 2 s − 1 ) or hyperintensity on calibrated T1w, with the remainder being classi ed as edematous tissue. Cutoff values of ADC were taken from the literature for Fluid and WM 21 , and hemorrhage [22][23][24] . Lastly, the edematous "high FLAIR" tissuetype was further sub-classi ed into Edema1 ("tumor-associated") or Edema2 ("leukoaraiosis") on the basis of observations in our development data that areas resembling leukoaraiosis that were far from the tumor were slightly hyperintense on unenhanced T1w compared with edematous regions that were adjacent to contrast-enhancing tumor.…”